POS0388 IMPACT OF GLUCOCORTICOIDS AND ANTI-OSTEOPOROTIC TREATMENT ON BONE HEALTH IN PATIENTS WITH INFLAMMATORY RHEUMATIC MUSCULOSKELETAL DISEASES (IRMD): A LONGITUDINAL STUDY
Authors: G. Adami, A. Fassio, C. Benini, O. Viapiana, D. Gatti, D. Bertelle, M. Rossini
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The negative effects of glucocorticoids (GCs) on the bone depend on dose and treatment duration. However, it is unclear whether a safe dose exists, especially for patients with inflammatory rheumatic musculoskeletal diseases (iRMDs). <h3>Objectives</h3> The primary objective of the present study was to determine, in a real-life setting, the risk of fragility fracture associated with the dose of glucocorticoids in iRMD. <h3>Methods</h3> We conducted a longitudinal cohort study on women with iRMD. Data were extracted from the DeFRA database (2012-2020). DeFRA is a fracture risk assessment tool similar to FRAX. Bone mineral density and fractures were assessed prospectively and compared to a matched cohort (propensity score matching, PSM with age, T-score and the % 10-year fracture risk estimated with DeFRA fracture risk assessment tool). Kaplan-Meier curves with log-rank test were made for iRMD (stratified for glucocorticoid use and dosage) and matched cohort respectively. <h3>Results</h3> 884 women with iRMD and 1,766 controls (age, T-score, and 10-year fracture risk matched) were included in the study and followed for up to 6 years. BMD levels decreased significantly in all GCs users not receiving anti-osteoporosis treatment (-4.26% p 0.0011, -4.23% p 0.0422, -2.66% p 0.0006 for ≥5 mg/day, 2.5 mg to 5 mg and 0 to 2.5 mg/day of prednisolone, respectively). As regards patients receiving anti-osteoporosis medications, BMD levels decreased significantly only in patients receiving ≥5 mg/day of pred eq (-3.01%, p 0.0012), whereas in patients receiving 2.5 mg to 5 mg and 0 to 2.5 mg/day, concomitantly treated with anti-osteoporotic drugs, BMD did not decrease significantly (+3.10% p NS, +1.12% p NS, respectively). <b>figure 1A</b>. Fracture incidence was greater in patients with iRMD compared to controls but only GC doses above 5 mg/day were associated with significantly higher risk of fracture <b>figure 1B</b>. 21, 12 and 29 fractures were reported for patients receiving ≥5 mg/day, 2.5 mg to 5 mg and 0 to 2.5 mg/day respectively, corresponding to a crude fracture rate of 4.8 fractures per 100 person-year, 2.8 fractures per 100 person-year and 2.5 fractures per 100 person-year respectively. 103 fractures were registered in the PSM cohort (crude fracture rate of 2.2 fractures per 100 person-year). We also explored the effects of GC on serum C-terminal telopeptide of type 1 collagen (CTX) in a subset of patients with available data (n=335). We found that the proportion of patients with low bone turnover (&lt;400 ng/L) was numerically greater in patients receiving ≥5 mg/day compared to other doses and controls (p NS) <h3>Conclusion</h3> GC doses as low as 2.5 mg/day were associated with BMD loss in iRMD but this effect was preventable. BMD loss in patients taking ≥5 mg/day was not totally prevented by anti-osteoporotic medications currently used in clinical practice, resulting in higher risk of fracture. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Giovanni Adami Speakers bureau: Theramex, Eli-Lilly, BMS, Amgen, UCB, Fresenius Kabi, Galapagos, Angelo Fassio: None declared, Camilla Benini: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Davide Bertelle: None declared, Maurizio Rossini: None declared.